Waiting List Application Form

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Please read the Student and Parent/Guardian expectations under the Enrollment tab before applying.

I have read through all the Program Information and Student and Parent/Guardian expectations. *
I fully understand and can commit to all expectations Music Haven has. *
I live in one the "Promise Zone" neighborhoods: Dixwell, Dwight, the Hill, Long Wharf, Newhallville, West Rock, or parts of Amity, Beaver Hills, Downtown, East Rock, Fair Haven, Quinnipiac Meadows or Prospect Hill. *
Child's Name *
Child's Name
Parent Name *
Parent Name
Date of Birth *
Date of Birth
Child's DOB
Address *
Phone *
School dismissal time? *
School dismissal time?